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When paradoxical adipose hyperplasia strikes

Patients who elect to have nonsurgical fat reduction with cryolipolysis are at risk for a complication in which a hardened area of localized fat develops post procedure, leaving patients with a bulge that requires the very treatments they tried to avoid for removal.

Risk of the complication, called paradoxical adipose hyperplasia, might be higher than the one in 4,000 treatment cycles, or 0.025% incidence, reported by the device’s manufacturer, researchers suggest in a new study. Authors of the study, published in the July issue of Plastic and Reconstructive Surgery, report paradoxical adipose hyperplasia’s incidence is 0.72%, or about one in every 138 cryolipolysis treatments.

Plastic surgeons looked retrospectively for all paradoxical adipose hyperplasia patients seen in their practice between May 2013 and May 2016. They identified eight men and three women with paradoxical adipose hyperplasia. All 11 patients were Hispanic.

Surgeons treated patients successfully with liposuction only or, as was the case with one patient, liposuction and abdominoplasty.

“In our series, 50% of the treated patients with liposuction required a second treatment for recurrence or persistent bulge,” they write.

The authors report that timing and patience are of the essence for successfully treating paradoxical adipose hyperplasia. They recommend that surgeons wait until the hardened tissue has softened, which takes about six to nine months post cryolipolysis. Physicians who remove the tissue too early risk a less optimal outcome and recurrence, they write.

Patience is required when explaining the problem and offering a solution dealing to these patients, who tend to be upset. When surgeons are attentive and successfully treat patients for paradoxical adipose hyperplasia, chances are good that patients will be satisfied despite the hurdles, according to the study.

Two patients with the complication refused further treatment, even though the treatment costs were covered by the equipment manufacturer, according to an American Society of Plastic Surgeon’s press release on the study.

There is no data looking at the long-term effects of procedures used to treat paradoxical adipose hyperplasia, they write.

Researchers coined the term paradoxical adipose hyperplasia in March 2014, in a case report published in JAMA Dermatology. The authors, at that time, reported paradoxical adipose hyperplasia’s incidence was 0.0051%.